Cauda Equina Syndrome and a Central Disc Prolapse

A central disc prolapse may lead to a condition called cauda equina syndrome. In this article we explain why this happens, what the symptoms are and how the condition should be treated.

Normal disc prolapse

In between each vertebra sits an intervertebral disc. These will deteriorate with age and small tears may develop. Because of these tears, it is possible that the outer shell will become so weakened that it will actually rupture, causing the inner shell (called the nucleus) to protrude outwards. This is known as a slipped, ruptured, herniated or prolapsed disc. A normal prolapse may then press upon the dorsal root ganglion in the spine, leading to symptoms of sciatica.

Central disc prolapse

These tears may occur anywhere in the intervertebral disc, and a small number will develop in the centre of the disc. This is known as a radial tear, and will lead to the nucleus protruding outwards and squashing the surrounding nerves into a small space. This is called a central disc prolapse. The prolapse may also press upon the nearby cauda equina nerves, so called because they resemble a horse’s tail.

Central disc prolapse and CES

If a central disc prolapse does press upon the cauda equina nerves, the nerves will quickly become damaged and begin to lose function. This neurological deficit may come on very suddenly (acute CES) or very gradually (chronic CES). The cauda equina nerves enable function and sensation in the genital region, the pelvic organs and the buttocks/legs. Therefore when the nerves are damaged, the following symptoms will arise:-

• Bilateral sciatica
• Weakness and numbness in the legs
• Perineal numbness
• Difficulty with urinary function
• Difficulty with bowel function

The aforementioned symptoms are called the ‘red flags’ of cauda equina syndrome. Any patient presenting with these symptoms must be sent for an urgent MRI scan. The following symptoms may also warrant an MRI:-

• Severe chronic back pain
• Severe sciatica
• Bilateral sciatica
• Severe restriction of straight leg raise

Treating CES

An MRI scan should reveal that the cauda equina nerves are being compressed by a central disc prolapse. If an MRI scan is not suitable – for example, because a patient has a pacemaker – at CT scan should be performed. Once cauda equina compression is confirmed, a patient should be sent for decompression surgery as a matter of urgency. If the condition is not yet complete, there is a chance that immediate surgery will prevent long-term complications.

If there is a delay in treating cauda equina syndrome and this can be attributed to medical error, there will be grounds for a compensation claim. Contact us today to discuss claiming compensation for cauda equina syndrome.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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